1225343965 NPI number — PRITCHETT EYE CARE PC

Table of content: (NPI 1225343965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225343965 NPI number — PRITCHETT EYE CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRITCHETT EYE CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRITCHETT EYE CARE ASSOCIATES (MOANA)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225343965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5961 LOS ALTOS PKWY STE 101
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89436-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-359-2020
Provider Business Mailing Address Fax Number:
775-359-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 W MOANA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-826-2477
Provider Business Practice Location Address Fax Number:
775-856-1524
Provider Enumeration Date:
08/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BENITZ
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
VP PECA
Authorized Official Telephone Number:
775-848-3859

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1225343965 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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